By: Sandra Yin, FierceHealthcare.com
Despite all the talk of efforts to enhance patient safety and improve quality of care, hospitals still have a long way to go. And what I’ve discovered since joining FierceHealthcare is that just about everyone I talk to has a hospital horror story that suggests we’ve got a long road ahead where patient safety is concerned. Here’s one account I heard recently.
Eleven years have passed since the landmark 1999 Institute of Medicine report, “To Err is Human,” came out with a guesstimate that up to 98,000 people are killed by hospital errors each year. That number is low compared to an estimate in a report issued this week by the Office of the Inspector General. According to that analysis, hospitals kill 180,000 people with medical errors each year.
To be specific, that number is conservative because it represents Medicare beneficiaries only. Even so, the death toll is the equivalent of one sardine-packed Boeing 747 crashing every day. If that happened, we’d hear about it for sure. It would be all over the news.
On Oct. 15, Yolanda Robles’ 95-year-old grandmother was admitted to a New York hospital for observation after a fall. But what should have been a 24-hour observation turned into a seven-day long stay that ended with discharge to a hospice.
Early on, a nurse failed to correctly identify her and gave her a drug prescribed to the patient in the room next door. The nurse later discovered she had the wrong patient after she told Robles’ grandmother that her blood sugar was high and that they would need to give her insulin. Robles’ aunt, who was staying with her grandmother, protested that her mother wasn’t a diabetic. Luckily, they were able to catch the mistake within an hour. Otherwise, the case of mistaken identities could have been fatal.
It gets worse.
Because Robles’ grandmother had developed an arrhythmia, the residents managing her care decided that it would be best to install a pacemaker. But the family said no. Apparently that didn’t make a difference. The next morning, a surgery crew came to prep her for surgery. But no informed consent had been signed. “It was insane,” Robles told FierceHealthcare. Robles, who is president of CulturaLink, a company that, among other things, helps healthcare organizations improve patient care by enhancing cultural competency, coached her aunt by phone on how to become a healthcare proxy.
Now in a hospice, Robles’ grandmother may have a few weeks left before she goes into that good night.
The situation at the hospital was probably compounded by limited English proficiency. Although Robles’ grandmother was listed as non-English speaking, no interpreter ever showed up during her stay.
The hospital’s reaction to the whole situation didn’t help, Robles said. It was matter-of-fact and no one expressed any real concern for what the family was going through. Robles filed a complaint with patient relations, only to learn that the hospital’s policy is not to divulge information about a root cause analysis to the family involved. She plans to file more complaints on up the chain of command.
This set me to wondering: Could it be that the hospital had become immune to the aftershocks of patient safety errors, because they are so common?
But these hospital-related deaths barely register. What goes on behind the doors of the hospital usually stays hidden. So-called “never” events or horrible mistakes like the one where a surgeon performed the WRONG SURGERY on a person are rarely publicized. Yet more transparency might help us tackle adverse events–especially the preventable ones.
But if you can’t talk about medical errors openly, how do you address the problem? – Sandra
Read more: Are hospitals growing numb to medical errors? – FierceHealthcare http://www.fiercehealthcare.com/story/are-hospitals-growing-numb-medical-errors/2010-11-19?utm_medium=nl&utm_source=internal#ixzz15xUXDMNP
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By: Barbara Smith, M.S., O.T.R.
http://barbarasmithoccupationaltherapist.com
Many seniors have low vision, yet they are not blind. The term “low vision” means that they have limitations that cannot be corrected with standard eye glasses or contact lenses. The most common diseases that cause low vision in the elderly population are macular degeneration and glaucoma. The low vision occupational therapist works in a patient’s home (which may be an assisted living or long term care facility) to help the patient be as independent as possible. The therapist may suggest ways to adapt the environment, use adaptive equipment or learn special viewing techniques to help patients perform activities of daily living including reading and writing.
How do Seniors Find Low Vision Services?
An ophthalmologist or low vision optometrist can make a referral for occupational therapy services. A person who has macular degeneration or glaucoma is probably already receiving treatment from an ophthalmologist (who is a medical doctor) that may include medication, injections or surgery. A low vision optometrist is specially trained to evaluate and prescribe lenses that increase functional skills such as reading or viewing a sports event.
Occupational therapy services are reimbursed by Medicare when the patient meets the criteria for low vision. This is defined as less than 20/60 acuity in the best corrected eye or significant loss of peripheral field. Many individuals with low vision meet this criteria and are not legally blind (with vision 20/200 or worse in best eye or severe field loss). However, individuals who are legally blind are also eligible for low vision occupational therapy services as well as services from the state agencies such as The Massachusetts Commission for the Blind.
What Happens at a Low Vision Evaluation?
The therapist will ask many questions related to how low vision is impacting the patient’s abilities to perform self-care skills such as bathing; daily living skills such as meal preparation or reading medication labels and recreational pursuits such as crafts or reading books. The therapist will also ask to walk around the home paying special attention to lighting, color contrast and areas with glare. Then the therapist will use this information to write a treatment plan with specific goals that the patient and therapist will work on together.
Examples of Low Vision Treatment
Treatment will vary depending on the setting. A patient who lives in a facility may not need to cook, clean or do laundry. Many patients are most interested in ways to enhance reading abilities. Such treatment might include:
- Exploring use of large print books or books on tape
- Recommendations on ways to improve lighting and decrease glare
- Discussion/demonstration of various types of adaptive equipment such as a talking clock or large numbered remote control.
- Determining whether the patient is a good candidate for services by a low vision optometrist who may prescribe very strong reading or distance glasses.
- Teaching techniques to use peripheral vision if person has macular degeneration or scanning techniques if the person has glaucoma.
- Information on available technologies that enlarge reading materials or create auditory access.
Patients who live in their own homes may benefit from home organization tips, safety adaptations, ways to increase color contrast and adaptive devices to increase function. Examples of these are:
- Locating most frequently used dishes on most accessible shelves
- Adding orange tape or paint to step edges to increase visibility
- Placing white soap in a blue dish to increase color contrast
- Using large print calendars, address books or check registries
- Tactile bumps placed on oven and stove to indicate setting by touch
Seniors with low vision are often amazed at how some very simple changes can greatly improve their quality of life. This home care service can help individuals with vision loss improve their quality of life in a variety of residential settings.
You see the ads everywhere these days—“Smart Drugs” for long life or “Arthritis Aches and Pains Disappear Like Magic!” or even statements claiming, “This treatment cured my cancer in 1 week.” It’s easy to understand the appeal of these promises. But there is still plenty of truth to the old saying, “If it sounds too good to be true, it probably is!”
Health scams and the marketing of unproven cures have been around for many years. Today, there are more ways than ever to sell these untested products. In addition to TV, radio, magazines, newspapers, infomercials, mail, telemarketing, and even word-of-mouth, these products are now offered over the Internet—with websites describing miracle cures and emails telling stories of overnight magic. Sadly, older people are often the target of such scams.
The problem is serious. Untested remedies may be harmful. They may get in the way of medicines prescribed by your doctor. They may also waste money. And, sometimes, using these products keeps people from getting the medical treatment they need.
False Hopes
Why do people fall for these sales pitches? Unproven remedies promise false hope. They offer cures that appear to be painless or quick. At best, these treatments are worthless. At worst, they are dangerous. Health scams prey on people who are frightened or in pain. Living with a chronic health problem is hard. It’s easy to see why people might fall for a false promise of a quick and painless cure. The best way for scientists to find out if a treatment works is through a clinical trial.
These scams usually target diseases that have no cures, like diabetes, arthritis, and Alzheimer’s disease. You may see ads for:
- Anti-aging medications. Our culture places great value on staying young, but aging is normal. Despite claims about pills or treatments that lead to endless youth, no treatments have been proven to slow or reverse the aging process. Eating a healthy diet, getting regular exercise, and not smoking are proven ways to help prevent some of the diseases that occur with age. In other words, making healthy lifestyle choices offers you the best chance of aging well.
- Arthritis remedies. Unproven arthritis remedies can be easy to fall for because symptoms of arthritis tend to come and go. You may believe the remedy you are using is making you feel better when, in fact, it is just the normal ebb and flow of your symptoms. You may see claims that so-called treatments with magnets, copper bracelets, chemicals, special diets, radiation, and other products cure arthritis. This is highly unlikely. Ads where people say they have been cured do not prove that a product works. Some of these products could hurt you, aren’t likely to help, and are often costly. There is no cure for most forms of arthritis. Rest, exercise, heat, and some drugs help many people control their symptoms. Don’t trust ads where people say they have been cured. This kind of statement probably doesn’t tell the whole story. If you are thinking about any new treatment, such as diet, a device, or another arthritis product, talk with your doctor first.
Clinical Trials: Evaluating Treatments
A clinical trial is a research study that tests how well new medical approaches work in people. Studies try to find ways to prevent, screen, diagnose, or treat a disease. Clinical trials may also compare treatments.
- Cancer cures. Scam artists prey on a fear of cancer. They promote treatments with no proven value—for example, a diet dangerously low in protein or drugs such as laetrile. Remember: There is no one treatment that cures all types of cancer. By using unproven methods, people with cancer may lose valuable time and the chance to benefit from a proven, effective treatment. This delay may lessen the chance of controlling or curing the disease.
- Memory aids. Many people worry about losing their memory as they age. They may wrongly believe false promises that unproven treatments can help them keep or improve their memory. So-called smart pills, removal of amalgam dental fillings, and certain brain retraining exercises are some examples of untested approaches.
- Dietary supplements. Americans spend billions of dollars each year on dietary supplements. These supplements are sold over-the-counter and include vitamins and minerals, amino acids, herbs, and enzymes. Most dietary supplements do not undergo government testing or review before they are put on the market. While some vitamins may be helpful, supplements may be bad for people taking certain medicines or with some medical conditions. Be wary of claims that a supplement can shrink tumors, solve impotence, or cure Alzheimer’s disease. Talk to your doctor before starting any supplement.
- Health insurance. Some companies target people who are unable to get health insurance. They offer coverage that promises more than it intends to deliver. When you think about buying health insurance, remember to find out if the company and agent are licensed in your State.
How Can You Protect Yourself From Health Scams?
Be wary. Question what you see or hear in ads or on the internet. Newspapers, magazines, radio, and TV stations do not always check to make sure the claims in their ads are true. Find out about a product before you buy. Don’t let a salesperson talk you into making a snap decision. Check with your health care provider first.
Remember the old stories about old snake oil salesman who traveled from town to town making wild claims for his fabulous product? Well, chances are that today’s scam artists are using the same sales tricks.
Look for red flags in ads or promotional material that:
- Promise a quick or painless cure
- Claim the product is made from a special, secret, or ancient formula
- Offer products and services only by mail or from one company
- Use statements or unproven case histories from so-called satisfied patients
- Claim to be a cure for a wide range of ailments
- Claim to cure a disease (such as arthritis or Alzheimer’s disease) that hasn’t been cured by medical science
- Promise a no-risk, money-back guarantee
- Offer an additional “free” gift or a larger amount of the product as a “special promotion”
- Require advance payment and claim there is a limited supply of the product
Two Federal government agencies work to protect you from health scams. The Federal Trade Commission can help you spot fraud. The Food and Drug Administration protects the public by assuring the safety of prescription drugs, biological products, medical devices, food, cosmetics, and radiation-emitting products. If you have questions about a product, talk to your doctor. Getting the facts about health care products can help protect you from health scams.
For More Information; Here are some helpful Federal and non-Federal resources:
Council of Better Business Bureaus: www.us.bbb.org
Federal Trade Commission: www.ftc.gov
Food and Drug Administration: www.fda.gov
National Cancer Institute: http://cis.nci.nih.gov
National Institute of Arthritis and Musculoskeletal and Skin Diseases: www.niams.nih.gov
Quackwatch, Inc.: Quackwatch, Inc., is a nonprofit corporation making information available to combat health-related fraud, myths, fads, and fallacies: www.quackwatch.org
U.S. Postal Inspection Service: https://postalinspectors.uspis.gov/
SOURCE: National Institute on Aging, Information Center, P.O. Box 8057, Gaithersburg, MD 20898-8057, 800-222-2225 (toll-free), 800-222-4225 (TTY/toll-free): www.nia.nih.gov
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By: National Care Planning Council
There are many decisions to be made when imminent death is approaching for a loved one. Questions regarding what type of care, medical assistance and even physical location for their last days confront us.
- If care at home has been given, should loved ones be moved to a facility or remain at home?
- If in a care facility should they be moved home for their last days?
- Will 24-hour care become necessary and more medical assistance be required?
If you are asking these questions, a Hospice service might be a good solution. Hospice can be provided to a person who has a life-limiting illness wherever that person lives. A nursing facility or long-term care facility can receive visits from hospice personnel in addition to the other care and services provided by the facility.
Hospice care is a special way of caring for a patient who is in the last stages of life. Hospice provides a team of professionals who aid the patient and family caregivers. This could include nurses, social workers, physicians, clergy and aides who all work together to plan and coordinate care, 24 hours a day or as needed.
The Hospice Foundation of America outlines the following services of hospice:
• Hospice is a special concept of care designed to provide comfort and support to patients and their families when a life-limiting illness no longer responds to cure-oriented treatments.
• Hospice care neither prolongs life nor hastens death. Hospice staff and volunteers offer a specialized knowledge of medical care, including pain management.
• The goal of hospice care is to improve the quality of a patient’s last days by offering comfort and dignity.
• Hospice care is provided by a team-oriented group of specially trained professionals, volunteers and family members.
• Hospice addresses all symptoms of a disease, with a special emphasis on controlling a patient’s pain and discomfort.
• Hospice deals with the emotional, social and spiritual impact of the disease on the patient and the patient’s family and friends.
• Hospice offers a variety of bereavement and counseling services to families before and after a patient’s death.
To be eligible for hospice a physician must certify the patient to be terminally ill with a life expectancy of six months or less and treatment for a cure is no longer provided. The focus for the patient has changed to supportive care and quality of remaining life.
Hospice is paid for by private insurance, Medicare or Medicaid Hospice Benefit or personal funds.
Here are the conditions that apply for Medicare Hospice Benefits:
• You are eligible for Medicare Part A (Hospital Insurance)
• Your doctor and the hospice medical director certify that you’re terminally ill and have 6 months or less to live if your illness runs its normal course.
• You sign a statement choosing hospice care instead of other Medicare-covered benefits to treat your terminal illness.
• You get care from a Medicare-approved hospice program
• You understand that Medicare will still pay for covered benefits for any health problems that aren’t related to your terminal illness. Medicare.gov
Special benefit periods apply to Medicare hospice care and some services do not apply.
Be sure to understand the rules and requirements of Medicare payment before you commit.
Hospice is available to anyone, regardless of age or illness. If Medicare or private insurance is not available, hospice services may be available for low income individuals through grants or charitable donations. Many hospices are non-profit and will provide services to anyone in need.
“Many families or their loved ones’ doctors often wait too long to order hospice. Hospice is a very valuable service and should be ordered at an earlier stage of illness. Many do not consider hospice for Alzheimer’s, degenerative old age or other debilitating illnesses where a person is going downhill fast. They should.
It is unfortunate that many people who died in a hospital emergency room or who received heroic treatments to prolong life in a hospital may have had the alternative of dying at home in familiar surroundings, with family or other loved ones at their side.
When someone is in crisis or appears to be going downhill fast but there really is no hope for recovery, family often call 911 and start a process which can result in great stress and great emotional discomfort. The loved one who is dying ends up in a hospital and may die there or be transferred to a nursing home where death eventually occurs.
When there is no longer hope for prolonging life, especially when this decision is made months in advance, hospice is usually a better alternative to other medical intervention”. National Care Planning Council
The days leading up to the moment of death of a loved one can be rich with meaning and expressions of love. Family and caregivers should allow others to help with the care and daily responsibilities. They need to free themselves from the details of caregiving and instead need to use hospice to allow more time to reminisce, give thanks for a life shared and say goodbye.
SOURCE: Tom Day from the National Planning Council
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Many Massachusetts hospitals and rehabilitation centers offer driving evaluations. Link to Medical Affairs Brochure.
How to Understand & Influence Older Drivers
“This booklet helps families and friends of older drivers understand when and how [driving] changes may be needed and how to keep older persons better connected to the people and activities that are important to them.”
http://www.nhtsa.dot.gov/people/injury/olddrive/UnderstandOlderDrivers
FAQ for caregivers
A. What should I do if my family member is showing signs of unsafe driving?
For some mature drivers, the transition from driver to passenger occurs easily. For others, giving up the keys may be a very difficult decision to make. AARP suggests steps one should take when a family member shows signs of unsafe driving. In some cases a driving evaluation, conducted at a hospital or rehabilitation center, may prove beneficial in determining if your family member is safe to operate. For a list of organizations that offer driving evaluations link to: www.mass.gov/rmv/medical/mabrochure.pdf
B. How do I bring up the subject of surrendering the keys?
According to AARP, the first conversations about safety should occur long before driving becomes a problem. See Family Conversations for helpful tips.
C. Can I report an unsafe driver to the RMV?
Yes. The RMV Medical Affairs Dept. accepts reports from: family members, physicians, law enforcement, or other interested third parties, including, but not limited to, members of the individual’s community (such as neighbors), private driving schools, physical therapists, etc.
Request for medical evaluation.
D. How do I report an unsafe driver to the RMV?
If an interested party chooses to report a possible unfit driver to the RMV, the report must be in writing and must be signed by the person making the report. The report must contain the name and address or name and telephone number of the complaining party. The report must contain identification of the individual whose driving ability is being questioned, including the name and at least one of the following: social security number, license, date of birth, and address. In addition, the report must contain the reason for the complaint and/or a description of the purported functional limitation.
Request for medical evaluation.
E. If I make a complaint, will it be confidential?
The RMV will not disclose this information to anyone over the telephone. However, in compliance with the public record’s law, if we receive a signed request from the person the complaint is about, then we will provide a copy of the original complaint.
SOURCE: AARP.org
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—Orly Avitzur, M.D., medical adviser, Consumer Reports
Waiting for a doctor can get frustrating, especially if you’re in a hurry. _______The next time you’re kept waiting, you may want to consider these:
1. Make a list of your top health concerns. If you organize them in advance, it can help us concentrate on your problem and provide you with optimal treatment. If you’re a new patient, we want to know the main reasons you’re here. If you’re a returning patient, we’d like to hear how you’ve been feeling since your last appointment. Focus on your most frequent or most severe symptoms, noting when they began, how often they occur, what makes them worse, and what makes them better.
2. Write questions down. It’s the easiest way to remember to ask them, and it will save you the hassle of making a follow-up phone call. Glance at the list as your appointment is winding down to see whether you’ve covered everything. It can also be useful to repeat the answers back to your doctor. That helps avoid potentially dangerous misunderstandings.
3. Make a list of all your medications. I’ve seen more medication errors than I care to admit. Some were due to drug interactions, others to dosage errors, and still others to drug-name mix-ups. That’s why I advise all of my patients to keep a complete list in their wallet of all the prescriptions, over-the-counter drugs, and dietary supplements they take, and update it whenever there’s a change.
4. Ask the office to check on your test results. We’re better able to give you answers during your visit if we have all your test results on hand, something that can’t be taken for granted in our fragmented system. If you’ve had any tests done since your last visit—laboratory work, scans, X-rays—ask the receptionist to see if the results are on file. If not, there may still be time to get the reports faxed to the office before your appointment starts.
5. Confirm that the office has the correct insurance information. We need this to get pre-authorizations for diagnostic tests and referrals to specialists, and to make sure that billing goes smoothly. Incorrect or expired information can hold up your treatment and lead to billing hassles later for you and your doctor.
6. Read something besides the magazines. In addition to brochures and pamphlets from patient organizations, waiting rooms often have reprints of articles we’ve found particularly helpful. While the Internet can be a great source of medical information, much of the material in our offices provides the added advantage of having been vetted. Just make sure you check the source; pharmaceutical company sales representatives like to leave promotional material, and they don’t always ask for permission.
—Orly Avitzur, M.D., medical adviser, Consumer Reports
SOURCE: Consumer Reports Health
This article first appeared in our January 2010 issue of Consumer Reports on Health.
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The facts; Older people tend to be more vulnerable than most to abuse. A subject hard to discuss – but very important to be aware of the signs of abuse!
Most such cases take place at the hands of family members, although others – including people working in nursing homes, assisted living centers and elsewhere – can be responsible. A bruise, broken bone or sudden behavior change could arise innocently, or they could be an indication of severe neglect or abuse.
Signs of physical abuse:
- Bruises and black eyes
- Marks on the body, including welts and cuts
- Sprains, dislocations and broken bones
- Rope marks or burns on hands and feet (perhaps indicating a person was tied up)
- Broken eyeglasses or frames
- New, upsetting behaviors
- Doesn’t want to be alone with his or her caregiver
- Tells you he or she is being physically hurt or mistreated
- Generally upset or agitated
- Increasingly withdrawn, not wanting to talk or interact with others
- Exhibits unusual behaviors like rocking, biting or sucking
Sexual abuse indications:
- Bruises on, around breasts or genitals
- Unexplained sexually transmitted diseases
- Torn, stained or bloody underwear
- Vaginal or anal bleeding, without a sound explanation
Changes around them:
- Caregiver won’t let anyone visit the elder by themselves, unless he or she is there, too
- Elder runs out of prescription medicine too quickly
- Lack of heat, electricity, water or other safety issues
- Excess dirt, fleas, lice, bad odors or other filth
Evidence of neglect:
- Poor hygiene
- Indications of dehydration
- Signals of malnutrition or poor diet
- Bed sores or other health problems that aren’t treated in a timely or proper manner
Source: National Women’s Health Information Center, U.S. Dept. of Health and Human Services
A wealth of organizations offer information for elders and their loved ones, specific to potential abuse, protection and other questions. The resources include:
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In the season of giving, charity cons do plenty of taking:
By: Sid Kirchheimer | from: AARP Bulletin |
During this season of giving, you may notice an increase in phone calls, e-mails or letters seeking charitable donations. Contributions to the country’s 400 biggest charities are down 11 percent this year, the largest decline in at least two decades, according to the Chronicle of Philanthropy. So fundraisers may be making special efforts.
But realize that this is also the season of taking: Although charity scams occur year-round, they are most common during the holiday season.
Scammers often use sound-alike names of well-known and respected charities. Or they invent ones purporting to help with four “hot-button” causes that target older donors in particular: police and firefighters, sick or needy children, victims of recent natural disasters, and veterans.
To add a feeling of authenticity, scammers who telephone may use “spoofing” technology that makes your caller ID screen display the name of a legit charity. And they also purchase e-mail and home mailing lists to send convincing but phony pitches for donations.
Unless you previously donated to a particular organization and provided your e-mail address, assume that all unsolicited e-mail requests for donations are scams. And don’t click on an attachment or link, which can unleash a computer virus.
Mailings that arrive at your home the old-fashioned way tend to be the most credible, but again, be suspicious of those from groups to which you’ve never previously donated.
Your defense: Before donating, take time to authenticate charities by checking names and reputations at the Wise Giving Alliance (operated by the Better Business Bureau), Charity Navigator or GuideStar. You can also contact the state agency that regulates charities where you live.
If you get a phone solicitation and are interested in donating, request that brochures and other paperwork be mailed to you. If the caller doesn’t have your address, don’t provide it — it could be useful if it’s a scammer on the line. Instead, obtain the organization’s phone number yourself, then call and ask if a phone campaign is under way. If the answer’s yes, it’s OK to give your address there for mailing of brochures and the like.
Printed material is no guarantee of legitimacy, but organizations that won’t provide it are typically bogus. Once you get the paperwork, confirm that the contact information and place to send your money matches what you’ve found on your own.
Once you’ve authenticated charities worthy of your money — ideally those that spend 25 percent or less of donations on fundraising and administrative costs — mailed personal checks are your safest form of payment. Never provide a credit card number to telemarketers (unless you initiate the phone call) and beware of any group that offers to send a courier to pick up cash or personal check at your home.
Source: Sid Kirchheimer is the author of Scam-Proof Your Life, published by AARP Books/Sterling.
The Elder Insider provides this information on an “AS-IS” basis with NO EXPRESS OR IMPLIED WARRANTY. YOU AGREE TO ACCEPT FULL RESPONSIBILITY FOR CONFIRMING AND DOUBLE-CHECKING ANY INFORMATION YOU CHOOSE TO USE.
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